General Surgery

Minimally invasive colectomy markedly reduces one-year mortality vs open in stage I–III colon cancer

An emulated trial of 21,931 NHS patients with stage I–III colon cancer compared elective minimally invasive surgery (MIS) with open surgery (OS). Observed one-year mortality was 2.9% after completed MIS vs 7.7% after OS. Causal modeling estimated MIS would reduce one-year mortality from 6.8% to 3.0%, with greatest absolute benefit in ≥85-year-olds, frail, and comorbid patients. Yet higher deprivation, frailty, comorbidity, and higher stage were all associated with lower odds of receiving MIS. 1

Neoadjuvant CAPOX does not improve 3-year DFS vs upfront surgery in locally advanced colon cancer

This phase III trial randomized 248 patients with CT-staged locally advanced colon cancer and ECOG 0–2 to upfront surgery or neoadjuvant CAPOX. Three cycles of neoadjuvant CAPOX followed by surgery did not improve 3-year disease-free survival vs upfront surgery (83% vs 87%; P = .36). Neoadjuvant chemotherapy was feasible, downstaged tumors, and reduced the proportion meeting criteria for adjuvant chemotherapy (59% vs 73%). Postoperative complications, adverse events, and quality of life were similar between groups. 2

Thermal ablation matches hepatectomy survival for solitary colorectal liver metastases ≤5 cm with fewer complications

A multicenter target trial emulation from 21 Chinese hospitals included 1,334 patients with solitary colorectal liver metastases ≤5 cm. After 1:1 propensity matching, 437 thermal ablation (TA) patients were compared with 437 hepatectomy (HT) patients. Median progression-free survival was similar: 1.81 years with TA vs 1.95 years with HT (HR 0.94; P = 0.41). Median overall survival was also comparable: 7.22 years with TA vs 8.09 years with HT (HR 0.89; P = 0.30), with similar 5-year rates. 3

EUS-guided gastrojejunostomy offers best clinical success and durability for malignant gastric outlet obstruction

This network meta-analysis pooled 8 RCTs (430 patients) comparing surgical gastrojejunostomy, stomach-partitioning GJ, EUS-guided GJ, and enteral stents for malignant gastric outlet obstruction. All surgical and stent strategies were significantly inferior to EUS-guided GJ for clinical success, with risk ratios around 0.82–0.91 vs EUS-GJ. Surgery was also inferior to enteral stents for clinical success and associated with longer hospital stays. Enteral stents had markedly higher reintervention risk than EUS-GJ and surgical GJ, despite similar technical success and severe adverse event rates. 4